GRAVIDADE DAS DOENÇAS RESPIRATÓRIAS DE CRIANÇAS E ADOLESCENTES ATRAVÉS DO VEF1: PERCENTUAL PREDITO VERSUS Z-ESCORE

Introdução: A espirometria é fundamental na avaliação de doenças pulmonares. A interpretação da gravidade do distúrbioventilatório obstrutivo (DVO) pelo percentual previsto do volume expiratório forçado no primeiro segundo (VEF ) proposta pela 1American Thoracic Society and European Respiratory Society (ATS/ERS) é controversa, por não considerar a idade. A análise doZ-Escore proposta por Quanjer pode corroborar com a resolução dessa limitação. Objetivo: Comparar a classificação da gravidadedo DVO proposta pela ATS/ERS e a estabelecida por Quanjer. Métodos: Estudo prospectivo e transversal, sendo realizados306 testes espirométricos em crianças e adolescentes (7 e 17 anos de idade) com doença respiratória entre 2017 e 2018.Pacientes com DVO foram classificados com padrão obstrutivo quando o VEF /capacidade vital (CV) encontrava-se abaixo do 5º 1percentil. Posteriormente, a gravidade do DVO foi estratificada em dois grupos: percentual predito do VEF e VEF em Z-Escore. 1 1Resultados: Dos 306 avaliados, 182 (59,5%) apresentaram DVO. Observou-se maior predomínio da população com diagnósticode asma (61%). Houve forte correlação (R=0,88) entre o Z-Escore e a porcentagem do valor predito do VEF . Contudo, quando 1estratificados os critérios de classificação da gravidade do DVO, foi observada fraca concordância (kappa = 0,285). Dos pacientescom DVO moderado (48,3%) pela porcentagem do valor predito do VEF foram classificados como graves pelo Z-Escore. 1Conclusão: Observou-se forte correlação linear entre o percentual predito do VEF e o Z-Escore. Entretanto, existem diferenças 1significativas entre as classificações. O percentual previsto do VEF tende a subestimar a gravidade do DVO em crianças e adoles- 1centes com doenças respiratórias.Palavras-chaves: Testes de Função Respiratória. Obstrução das vias respiratórias. Espirometria. Crianças. Adolescente

SARS-CoV-2 recombinant proteins stimulate distinct cellular and humoral immune response profiles in samples from COVID-19 convalescent patients

OBJECTIVES: In this preliminary study we investigated cellular and humoral immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens in blood samples from 14 recovered coronavirus disease 2019 (COVID-19) patients and compared them to those in samples from 12 uninfected/unvaccinated volunteers. METHODS: Cellular immunity was assessed by intracellular detection of IFN-γ in CD3+ T lymphocytes after stimulation with SARS-CoV-2 spike (S1), nucleocapsid (NC), or receptor-binding domain (RBD) recombinant proteins or overlapping peptide pools covering the sequence of SARS-CoV-2 spike, membrane and nucleocapsid regions. The humoral response was examined by ELISAs and/or chemiluminescence assays for the presence of serum IgG antibodies directed to SARS-CoV-2 proteins. RESULTS: We observed differences between humoral and cellular immune profiles in response to stimulation with the same proteins. Assays of IgG antibodies directed to SARS-CoV-2 NC, RBD and S1/S2 recombinant proteins were able to differentiate convalescent from uninfected/unvaccinated groups. Cellular immune responses to SARS-CoV-2 protein stimuli did not exhibit a specific response, as T cells from both individuals with no history of contact with SARS-CoV-2 and from recovered donors were able to produce IFN-γ. CONCLUSIONS: Determination of the cellular immune response to stimulation with a pool of SARS-CoV-2 peptides but not with SARS-CoV-2 proteins is able to distinguish convalescent individuals from unexposed individuals. Regarding the humoral immune response, the screening for serum IgG antibodies directed to SARS-CoV-2 proteins has been shown to be specific for the response of recovered individuals

Há associação entre o valor do volume expiratório forçado no 1º segundo e o Teste de Controle da Asma e a classificação do grau de controle proposta pelo Global initiative for Asthmaem crianças e adolescentes asmáticos tratados com corticosteroide inalató

Objective: Evaluate the presence of association between the classification of the level of asthma control, using the method proposed by the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT)/Childhood-ACT and the forced expiratory volume in the 1st second (FEV1), in asthmatic children and adolescents treated with inhaled corticosteroids, followed up at the National Institute of Women's, Children's and Adolescents' Health FernandesFigueira of the Oswaldo Cruz Foundation (IFF / FIOCRUZ). Method: A cross-sectional study was carried out with a review of the medical records of all children between 7 and 17 years of age followed up at the Asthma Outpatient Clinic and referred to the Respiratory Insertion Test (PFR) sector between March 2013 and September 2014. In the same day were applied the C-ACT/ACT questionnaires, an asthma control method proposed by the GINA and the FEV1 value in a spirometrictest. Results: From the total number of records evaluated (72), 16 children were excluded because they did not meet the required criteria for performing spirometry. The sample studied (56 children) was predominantly male (58.9%) and median age was 12 (7-17) years. It was observed an association between FEV1 and GINA values ??(p <0.01). Conclusion: The results found in this study indicate that FEV1 measurement is a useful component among the instruments for assessing clinical control of asthma by GINA.Objetivo: Avaliar a presença de associação entre a classificação do grau de controle da asma, usando a proposta pelo Global initiative for Asthma(GINA), o AsthmaControl Test (ACT)/Childhood-ACT, e o volume expiratório forçado no 1º segundo (VEF1), em crianças e adolescentes asmáticos em tratamento com corticoide inalatório, atendidos no Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira da Fundação Oswaldo Cruz(IFF/FIOCRUZ). Método: Estudo transversal, com revisão de prontuários de todas as crianças entre 7 e 17 anos acompanhadas no Ambulatório de Asma e encaminhados ao setor de Prova de Função Respiratória (PFR) entre março de 2013 e setembro de 2014. Foram aplicados no mesmo dia, os questionários C-ACT/ACT, a classificação do grau de controle da asma proposta pelo GINA e o valor do VEF1 obtido em exame espirométrico. Resultados: Do total de prontuários avaliados (72), 16 crianças foram excluídas por não preencherem os critérios exigidos para realização da espirometria. A amostra estudada (56 crianças) apresentou predomínio do sexo masculino (58,9%) e mediana de idade igual a 12 (7-17) anos. Observou-se associação entre os valores de VEF1 e o GINA (p<0,01). Conclusão: Os resultados encontrados nesse estudo indicam que a medida do VEF1é um componente útil dentre os instrumentos para avaliação do controle clínico da asma pelo GINA

Avaliação da correlação entre a medida da fração exalada de óxido nítrico e as medidas espirométricas em crianças e adolescentes asmáticas

Contém tabelas, ilustrações e gráficosIntrodução: A asma é uma doença inflamatória crônica e apresenta limitação variável ao fluxo aéreo, reversível espontaneamente ou com tratamento. No qual, se faz necessário uma monitoração adequada. A avaliação clínico-funcional é útil para o diagnóstico de asma, porém limitada para avaliar de forma precisa a intensidade do processo inflamatório nas vias aéreas. Objetivo: Avaliar a correlação dos níveis de inflamação das vias aéreas através da fração exalada de óxido nítrico com o grau de obstrução da função pulmonar através do volume expiratório forçado no primeiro segundo de acordo com a American Thoracic Society em crianças e adolescentes asmáticas. Metodologia: Estudo do tipo retrospectivo, observacional, descritivo e transversal. Foi realizado através da análise do banco de dados do setor de Prova de Função Respiratória de crianças e adolescentes entre 7 e 17 anos encaminhadas do Ambulatório de Asma Grave do Instituto Fernandes Figueira/Fiocruz. Resultado: Foram analisados os valores da FeNO e dos parâmetros espirométricos de 57 pacientes, 45 preencheram os critérios de inclusão. Vinte e nove crianças e adolescentes eram do sexo masculino (64.4%) e dezesseis do sexo feminino (35.6%). A média da idade total dessa amostra foi de 10.9±2.54 anos. Em relação a comparação entre o grau de classificação da asma, o distúrbio funcional e o tratamento com corticoide inalatório com a FeNO, Todos os pacientes apresentaram níveis elevados (>34 ppb). Porém a mediana dos níveis da FeNO foi mais elevadas (>43 ppb) no grupo sem obstrução, a diferença entre os grupos foi estatisticamente significativa (p=0,04). A mediana dos níveis da FeNO foi mais elevada no sexo feminino do que no sexo masculino. Em ambos os sexos a mediana dos valores espirométricos, encontravam-se na faixa de normalidade. Não encontramos correlação entre a FeNO e FEV1 (r = -0,14, p= 0,36) e a FeNO com capacidade vital forçada (r=- 0,34, p=0,02). Conclusão: Os resultados sugerem que a medida da FeNO não é melhor que a espirometria para o diagnóstico da asma. Porém é possível que a medida da FeNO possa ser um marcador da resposta à corticoterapia inalatória em crianças e adolescentes asmáticas independentemente da avaliação funcional respiratóriIntroduction: Asthma is a chronic inflammatory disease and presents variable airflow limitation, reversible spontaneously or with treatment. In which, if proper monitoring is necessary. The clinical and functional evaluation is useful for the diagnosis of asthma, but limited to assess accurately the intensity of inflammation in the airways. Objective: To evaluate the correlation between the levels of inflammation in the airways through the fractional exhaled nitric oxide to the degree of lung function obstruction by forced expiratory volume in one second according to the American Thoracic Society in asthmatic children and adolescents. Methodology: Study of retrospective type, observational, descriptive and cross. It was conducted by analyzing the Respiratory Function Test industry database of children and adolescents between 7 and 17 years directed the Asthma Clinic Record Fernandes Figueira Institute / Fiocruz. Results: We analyzed values of FeNO and spirometric parameters of 57 patients, 45 met the inclusion criteria. Twenty-nine children and adolescents were male (64.4%) and sixteen female (35.6%). The average overall age of the sample was 10.9 ± 2:54 years. Regarding the comparison between the level of classification of asthma, functional disorder and treatment with inhaled corticosteroids with FeNO, All patients had high levels (> 34 ppb). However the median of exhaled nitric oxide levels was higher (> 43 ppb) in the group without obstruction, the difference between groups was statistically significant (p = 0.04). The median FeNO levels were higher in females than in males. In both sexes the median of spirometric values were in the normal range. We found no correlation between FeNO and FEV1 (r = -0.14, p = 0.36) and FeNO with forced vital capacity (r = - 0.34, p = 0.02). Conclusion: The results suggest that measurement of exhaled nitric oxide is not better than spirometry for the diagnosis of asthma. However it is possible that the measurement of FeNO may be a marker of response to inhaled corticosteroid therapy in children and adolescents with asthma regardless of respiratory function testing52 f

ASSOCIATION BETWEEN FRACTION OF EXHALED NITRIC OXIDE AND SPIROMETRY DATA AND CLINICAL CONTROL OF ASTHMA IN CHILDREN AND ADOLESCENTS

<p></p><p>ABSTRACT Objective: To evaluate the association between fraction of exhaled nitric oxide (FeNO) values and forced expiratory volume in the first second (FEV1) and the level of asthma control, as proposed by the Global Initiative for Asthma (GINA), in asthmatic children and adolescents attended at the National Institute of Women, Children and Adolescents Health Fernandes Figueira of Fundação Oswaldo Cruz (IFF/FIOCRUZ). Methods: This was a cross-sectional study, with a review of medical records of 90 asthmatics between 7 and 17 years old, who were followed up at the IFF/FIOCRUZ Asthma Outpatient Clinic and were referred to perform respiratory function tests (RFT)between March 2013 and September 2014. After classification according to GINA, patients performed complete spirometry and FeNO measurement. Subsequently, they were separated into two groups: regular and non-regular inhaled corticosteroid (ICS) use, regardless of the ventilatory pattern in spirometry. Results: The association between FEV1 values and the degree of asthma control according to GINA (p=0.001) was observed in all patients, regardless of ICS use, but there was no association between FEV1 and levels of FeNO. Conclusions: The correlation observed between GINA and FEV1 reinforces the importance of spirometry in the clinical follow-up of these patients. Although no association was found between the value of FeNO and the degree of asthma control and FEV1, FeNO may be an early method to detect airway inflammation, even before the symptoms and spirometric changes.</p><p></p

Respiratory manifestations in late-onset Pompe disease: a case series conducted in Brazil

ABSTRACT Objective: To describe respiratory function in a series of patients with late-onset Pompe disease after the definitive diagnosis and before enzyme replacement therapy. Methods: This was a cross-sectional study involving patients with a definitive molecular diagnosis of late-onset Pompe disease. The data analyzed included age at symptom onset; age at definitive diagnosis; type of initial symptoms; time from symptom onset to diagnosis; FVC in the sitting and supine positions; six-minute walk distance; and locomotor ability. Analyses were carried out using frequencies, medians, minimum values, and maximum values. Results: Six patients were included in the study. The median age at symptom onset was 15 years (range, 13-50 years), and the median age at diagnosis was 39.5 years (range, 10-64 years). The median time from symptom onset to diagnosis was 8 years (range, 0-45 years). In all cases, the initial manifestation of the disease had been motor weakness. The median FVC in percentage of the predicted value (FVC%) in the sitting and supine positions was 71.0% (range, 22.9-104.6%) and 58.0% (range, 10.9-106.9%), respectively. The median ΔFVC% was 24.5% (range, −4.59 to 52.40%).The median six-minute walk distance was 391.7 m (range, 97-702 m) . Conclusions: In this case series, the time from symptom onset to diagnosis was long. Although respiratory signs or symptoms were not the initial manifestations of the disease, 66.7% of the patients showed reduced FVC% in the sitting and supine positions at diagnosis